A4 Quality and Regulatory Update

What is a PCMH-N (Patient Centered Medical Home-Neighborhood) and how does it relate to A4?

• PCMH-N is a BCBSM program developed to strengthen the relationship between specialists and primary care physicians in the delivery and coordination of care, and to assist each provider in achieving higher levels of patient engagement and care coordination.

• This is an effective way of improving and achieving population health management. Being a part of aPCMH-N office means the healthcare team is committed to following the basic foundation for this program across our member population regardless of their insurance. Thus, improving the quality of care the patient receives while also lowering the cost of care for the patient. Specialists are then rewarded for their part in delivering effective and efficient care when receiving their Value Based Reimbursement Uplifts.

• There are 12 PCMH domains of function derived from The National Joint Care Principles of the Patient-Cen tered Medical Home. They are:

1. Coordination of Care

2. Extended Access

3. Individual Care Management

4. Linkage to Community Services

5. Patient-Provider Partnership

6. Patient Registry

7. Patient Web Portal

8. Performance Reporting

9. Preventative Services

10. Self-Management Support

11. Specialist Referral Process

12. Test Results Tracking